Physiological Response of Cortisol to Cardiac Catheterization

Presentation Number: SAT-400
Date of Presentation: March 7th, 2015

Valentina D. Tarasova*1, Kinjal K Shah2, Michael D. White1, Robert J Anderson3 and Laura Anne Graeff Armas1
1Creighton University, Omaha, NE, 2VA-Nebraska Western Iowa Healthcare System, Omaha, NE, 3VA - Nebraska Western Iowa Healthcare System / Creighton University Medical Center, Omaha, NE

Abstract

Objective: Activation of the hypothalamic-pituitary-adrenal (HPA) axis is a universal response to stressors and the cortisol level has been used to reflect the degree of stress. Cortisol increase has been well documented in critical illnesses, sepsis, trauma and surgery. Currently there are limited data available on the physiological cortisol response to cardiac catheterization.

Research design and methods: Twenty three subjects (18 males, 5 females, all Caucasians) ages 44 to 82 years without known history of adrenal insufficiency or HPA suppression had serial serum cortisols drawn on the day of elective cardiac catheterization. The first serum cortisol level was obtained prior to the procedure and the second, third and fourth levels during the procedure at 15 min, 30 min and at the end of the procedure, respectively). The fifth and final cortisol level was drawn approximately 4 hours after cardiac catheterization. Serum albumin level was also obtained with the initial blood draw. Anxiety and pain levels were assessed before the procedure. Study participants had a follow up blood sample 4-6 weeks after the procedure timed to coincide with the pre-procedure blood draw.

Descriptive statistics were generated using the statistics package, PASW Statistics 21.0. Nonparametric expressions were reported (Median and interquartile range [IQR]). Bivariate correlations were performed using Spearman’s rho.

This trial was registered on clinicaltrials.gov in March 2013 (NCT01822847).

Results: The median serum cortisol level prior to the procedure was 10.55 (6.43-14.58) mcg/dL with an albumin of 4 (3.8-4.1) g/dL. At 15 min during cardiac catheterization, the serum cortisol was 7.7 (4.9-9.5) mcg/dL, at 30 min, 6.1 (4.5-9.33) mcg/dL and at the end of the procedure, 6.3 (4.4-8.25) mcg/dL. Serum cortisol was 5 (3.65-7.7)mcg/dL about 4 hours after cardiac catheterization. Serum cortisol levels at 15 and 30 minutes and post catheterization were significantly correlated (p=0.002). The duration of the procedure was 44 min (range of 30-62). No complications were identified. Five subjects had coronary stents placed. The average dose of Fentanyl was 100 mcg (range of 75-100) and Midazolam (Versed) 4 mg (range of 3.25-6). Fentanyl and Versed doses were significantly correlated with cortisol levels obtained after cardiac catheterization by Spearman correlation (p=0.023 and p=0.046, respectively).

Conclusions: Serum cortisol levels decreased slightly during elective cardiac catheterization. The cortisol decrease can be explained by Fentanyl and Versed suppression of the HPA axis. On the other hand, cardiac catheterization could be perceived by patients as a minor, non-stressful procedure potentially due to sedative effects of Fentanyl and Versed.

 

Nothing to Disclose: VDT, KKS, MDW, RJA, LAGA